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3176 Newly Diagnosed Myeloma (MM) Patients (Pts) with High-Risk (HR) Cytogenetics By FISH: Is There a Role for Tandem Autologous Stem Cell Transplantation (ASCT)?

Clinical Autologous Transplantation: Results
Program: Oral and Poster Abstracts
Session: 731. Clinical Autologous Transplantation: Results: Poster II
Sunday, December 6, 2015, 6:00 PM-8:00 PM
Hall A, Level 2 (Orange County Convention Center)

Sara Farshchi-Zarabi, MD1,2*, Gurdeep Parmar, MD2*, Esther Masih-Khan, PhD2*, Sophia Farooki, MD, FRCPC2, Christine Chen, MD, FRCPC2,3, Vishal Kukreti, MD, FRCPC2,3, Anca Prica, MD, FRCPC2,3*, Rodger Tiedemann, MBChB, FRCPC, PhD2,3, Suzanne Trudel, MD3,4 and Donna Reece2,3

1Department of Medicine, University of Toronto, Toronto, ON, Canada
2Princess Margaret Cancer Centre, Toronto, ON, Canada
3Department of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada
4Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada

Background: Recent analyses have suggested that newly diagnosed multiple myeloma (MM) patients with the high-risk (HR) chromosomal abnormalities del 17p and t(4;14) detected by FISH may benefit from bortezomib (BTZ)-based induction therapy and tandem autologous stem cell transplantation (ASCT) (Sonneveld P et al, J Clin Oncol 2013;31: 3279). At Princess Margaret Cancer Centre, we have offered upfront tandem ASCT for HR pts with del 17p, t(4;14) and/or t(14;16) and now retrospectively review the results of this approach.

Methods: After obtaining Institutional Research Ethics Board approval, we used Princess Margaret Myeloma Database to identify HR MM pts who underwent tandem ASCT between June 2005 and January 2015.  We performed a retrospective chart review to investigate the survival outcome of this group of patients.

Results: Between 06/05 and 01/15, 52 HR pts underwent tandem ASCT at Princess Margaret Cancer Centre. 21 had del 17p, 20 had t(4;14), 5 had t(14;16), 3 had both t(4;14) + del 17p and 3 had both t(14;16) + del 17p. Median age was 56.5 yrs (range 31-71); 34 were male. ISS stage was I in 12, II in 15, III in 12 and N/A in 13 pts. The majority (42 pts) received BTZ-based induction therapy which consisted of CyBorD in 38; 11 pts required a 2nd regimen before ASCT. The median time from diagnosis to 1st ASCT was 6.7 mos (range 4.8 -45.7) and the median time between transplants was 3.7 mos (range 0.9- 6.6); 30 pts received lenalidomide (len) between ASCTs to prevent early relapse. All but 2 pts (96%) received maintenance therapy after the 2nd ASCT which included thalidomide in 7 (13%), len +/- steroids in 39 (75%) and BTZ +/- len in 4 (8%) of all pts. Thirty-six (69%) received both BTZ-based induction and len maintenance after the 2nd ASCT. No transplant-related deaths occurred. Median follow-up is 26.3 mos (range 9.1 to 104.3).

The median overall survival in all 52 pts from diagnosis was 31.1 mos (range 11.9 to 110.8) with a median PFS of 24.0 mos (9.1 to 83.6); median survival after progression was only 8.2 mos (0.1-62.8) mos in the 16 pts who relapsed after the 2nd ASCT.

HR Group

#

Calculated from diagnosis

Calculated from 2nd ASCT

Median PFS, mos (range)

Median OS, mos (range)

Median PFS, mos (range)

Median OS, mos (range)

t(4;14)

23

22.4

(11.4-58.1)

29.9

(17.7-84.4)

7.0

(0.2-23.5)

17.3

(5.4-73.6)

Del 17p

27

24.4

(9.1-83.6)

35.0

(11.9-110.8)

11.2

(1.3-69.4)

25.3

(3.8-99.6)

t(14;16)

8

27.4

(10.3-55.4)

30.6

(11.9-55.4)

16.9

(2.2-48.1)

19.7

(3.8-48.1)

Both BTZ-induction + len maint

36

22.2

(10.3-55.4)

30.5

(11.9-67.5)

8.1

(1.4-48.1)

18.7

(3.8-57)

No  BTZ-induction + len maint

16

27.2

(9.1-83.6)

49.5

(22.0-110.8)

12.1

(0.2-69.4)

24.5

(6.9-99.6)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Conclusions:   1) MM pts with HR cytogenetics, particularly those with t(4;14), have a short PFS and OS after tandem ASCT; 2) even following BTZ-based induction therapy and len maintenance, outcomes with tandem ASCT are suboptimal in HR pts; 3) further investigations are necessary to identify novel strategies for the management of HR MM in the era of modern therapeutic agents.

 

Disclosures: Chen: Celgene: Consultancy , Honoraria , Research Funding . Kukreti: Janssen Ortho: Honoraria ; Roche: Honoraria ; Lundbeck: Honoraria ; Amgen: Honoraria ; Celgene: Honoraria . Tiedemann: Janssen Ortho: Honoraria ; Celgene: Honoraria ; Amgen: Honoraria . Trudel: Oncoethix: Research Funding ; Novartis: Honoraria ; Trillium Therapeutics Inc.: Research Funding ; BMS: Honoraria ; Amgen: Honoraria , Speakers Bureau ; Celgene: Equity Ownership , Honoraria , Speakers Bureau . Reece: Lundbeck: Honoraria ; Celgene: Consultancy , Honoraria , Research Funding ; Novartis: Honoraria , Research Funding ; Otsuka: Research Funding ; Merck: Research Funding ; Millennium Takeda: Research Funding ; Bristol-Myers Squibb: Research Funding ; Amgen: Honoraria ; Onyx: Consultancy ; Janssen-Cilag: Consultancy , Honoraria , Research Funding .

*signifies non-member of ASH